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Transcript of virtual press conference with Dr Keiji Fukuda, Special Adviser to the Director-General on Pandemic Influenza (WHO, 2/24/10, edited)

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  • Transcript of virtual press conference with Dr Keiji Fukuda, Special Adviser to the Director-General on Pandemic Influenza (WHO, 2/24/10, edited)

    Transcript of virtual press conference with Dr Keiji Fukuda, Special Adviser to the Director-General on Pandemic Influenza (WHO, 2/24/10, edited)

    [Source PDF Document: LINK. MP3 Audio File: LINK. EDITED.]

    Transcript of virtual press conference with Dr Keiji Fukuda, Special Adviser to the Director-General on Pandemic Influenza

    24 February 2010

    Gregory Hartl:
    Good morning. It is 11 o'clock here in Geneva and welcome to the World Health Organization's virtual press briefing. Today Dr Keiji Fukuda Special Adviser to the Director-General for Pandemic Influenza will be speaking about the deliberations and outcome of the Emergency Committee Meeting which occurred yesterday so I would first like to remind you that shortly after this briefing is over the audio file will be up on the WHO website and later in the day, that will be followed by a written transcript and now I would like to turn over to Dr Fukuda.

    Dr Fukuda:
    Thank you, Gregory. Again thank you everybody for joining this virtual press conference. What I will do today is discuss the meeting of the International Health Regulations Emergency Committee which met yesterday and had its 7th discussion since the start of the pandemic. This meeting was held as a teleconference meeting and the discussions were quite interesting and I think, important. Now the Emergency Committee was convened for two main purposes. The first one was to provide the Director-General with the Emergency Committee's views on the status of the pandemic; where we stand right now. The second thing was the Committee was asked to address and review the current temporary recommendations which are in place. These temporary recommendations are reviewed as a matter of course every three months as part of the International Health Regulations.

    Yesterday's discussion lasted about 2 hours and it was really a quite in depth discussion about the current situation. Based on the evidence that was presented in that discussion and based on the subsequent discussions and the views of the Emergency Committee the Director-General decided that it was appropriate not to make any changes in the current pandemic phases right now and that she would reconvene the Emergency Committee some time in the next several weeks to again review the pandemic situation.

    Let me give you some insight into the Emergency Committee's deliberations. Now the discussions that were held among the members were quite in depth and they went over the epidemiological situation in some detail and they also raised a number of other
    issues and concerns among the Emergency Committee. So in terms of the epidemiology the Emergency Committee noted that pandemic activity is at different places in different parts of the world. So for example they noted that pandemic activity is clearly declining or is low in many parts of the world, in many countries. So for example, over the past few weeks we have talked about how activity is low in places such as North America, in Western Europe and in a number of other places in the world. But we have also noted that there has been some ongoing activity going on in other parts of the world. Such as Eastern Europe, parts of Eastern Europe, parts of Central Asia and so on.

    Then more recently the Committee also noted that there are increasing reports of pandemic activity occurring in Western Africa. So in the past few weeks we have reviewed the situation where we are seeing the first reports of community activity occurring in countries such as Senegal and Mauritania. Now in terms of some other concerns that were raised by the Emergency Committee. One, they noted that the Southern Hemisphere is going to be entering its winter months and this is a period of time in which increased influenza activity should be anticipated including pandemic activity. A second point is that we noted that in some countries there had been two significant waves of activities whereas in other countries there had been only one wave of activity which has occurred so far.

    Then finally they had some concern that any actions should not undermine any of the control actions being taken place by different countries and so nothing that the Emergency Committee should advise on, should really harm the efforts of countries to try to deal with the influenza activity. So on this basis the Emergency Committee provided its views to the Director-General that it was really too early to conclude that the pandemic was in a post peak period in many countries and that the Emergency Committee should come back and revisit the epidemiological situation in the next several weeks when there is more information to be looked at.

    Now let me also provide some other observations about this discussion. I think that the discussion really highlighted a lot of the real world complexities of dealing with a large event like a pandemic. They underscored on the one hand, the need for pandemic plans, these kinds of plans are essential for helping countries to be prepared and to coordinate their preparations and actions in dealing with something like the pandemic. When we look at the current plans these really reflect the ongoing work by scientists
    since really the late 1990s to try to provide updated guidance and based on an extensive amount of real world experience plus scientific knowledge. They also noted that the current plans - the current pandemic plans - which came out in 2009 also reflect concern over the more severe kinds of influenza pandemics and this has really been driven by the fact that we have been dealing with avian influenza, avian H5 and H1 influenza for a number of years and it remains a concern for countries.

    But this discussion also highlighted the need for everyone to keep their eyes open to reality and to see what is going on and not just to look at plans. And so in the current situation we really see that this pandemic is on the less severe end of severity. Again we don't really know what the final impact is and we won't know what it is until a year or two after the pandemic is over but it appears to be on the less severe side of the spectrum of pandemics that we have seen in the 20th century. It's also clear that in the current situation countries are in different situations in terms of disease and epidemiology. What is being seen in one country is not necessarily what is being seen in other countries in other parts of the world. Then finally, I think these discussions highlighted that countries are also in different places in terms of their efforts to mount control programmes and to deal with the pandemic and so, for example, in some countries we have seen that vaccination has been going on now for some months whereas in other countries similar sorts of efforts have really yet to get started.

    Then I think the discussions also underscored one reality that we always deal with in dealing with an event like the pandemic which is that there are fundamental limitations in terms of knowing what course the pandemic is going to take. We are always unsure whether there are going to be significant changes in the future but we know that that can happen and if they are going to happen we don't know what they might be or when they may occur. This is really something that we have always had to deal with.

    So if you look at this and you say what does this mean? I think it really boils down to a couple of points. On the one hand it's clear that we need pandemic plans and guidance because it's really essential for helping countries to plan their activities and to deal with the situation.

    On the other hand these actions really have to be flexible. We have to keep our eyes open to reality to see what is going on, on the ground and then adjust our plans and actions as dictated by that reality. So we have to be flexible. So this is really a lot to ask of groups like the Emergency Committee and also of health authorities but really this is what they must do. They have to balance these two things.

    So in closing before I move on to questions let me just summarize. WHO is not calling for any changes to pandemic phases right now. WHO is also not making any changes in its recommended actions at this time and that the Emergency Committee will be convened some time in the future, within the next several weeks to review the situation again and then we will come back and look at the pandemic situation and see if there are any changes in phases or recommendations at that time. So let me stop here and then we will turn it over to questions as normal. Thank you.

    Gregory Hartl:
    Dr Fukuda thank you very much for those introductory remarks. Before we move over to questions may I remind journalists please that if you wish to ask a question please dial 01 on your key pad. So the first question is from Frank Jordan of Associated Press in Geneva. Go ahead please Frank.

    Frank Jordans. Associated Press:
    Good morning Dr Fukuda. The way I understand it is that the Committee found the situation was more volatile in the Southern Hemisphere and more stable in the Northern Hemisphere. Could you tell me if they made any recommendations specific to either of those about what countries can and should do at this stage now?

    Dr Fukuda:
    Thanks Frank. I think it's probably more fair to say that they didn't find the situation more volatile in the Southern Hemisphere but what they noted is that with the Southern Hemisphere's winter months coming up that this is traditionally the time when we expect to see higher levels of activity and that they were noting that, and they were saying that it was possible that we would be seeing things in the Southern Hemisphere which could be much higher than would be expected with seasonal influenza. So I think it was really more a note of caution about what the future could bring in the Southern Hemisphere. And so at this time they did not make any recommendations which were specific either to the Southern or Northern Hemisphere and make any distinctions here. Thank you.

    Gregory Hartl:
    Thank you. The next question is from Jamil Chade - you're in Geneva. Go ahead Jamil.

    Jamil Chade:
    Thank you Gregory. Mr Fukuda you mention the vaccination issue. Brazil will start its vaccination and campaign next week. I understand that what you said if you would make any changes at this point it would basically change the behaviour of people going to the centres to get vaccinated, but the fact is that we have seen in Europe that the vaccination process was very weak. So my question is, is it really necessary, this measure, at this point of time, in Brazil?

    Dr Fukuda: good question. Right now the situation with the pandemic virus can be summarized this way. We have seen that this has been by far the dominant virus around the world over the past year, and all indications are that this virus will be around for quite a long time. And secondly, we have seen that this virus has really caused its more most severe impacts in certain groups. And so for example, we have seen, as I mentioned in the past, that pregnant women and younger people are more likely to develop severe disease. Thirdly, we have now seen that over 300 million people, an estimated 300 million people or more, have now been vaccinated against pandemic influenza and that the safety record of the vaccine has been excellent. We have not seen any unusual safety events occur.

    And then finally, we are now becoming to see the first reports coming out in which the effectiveness of the vaccine is about seven to seventy-five percent, which is quite high, that we have a vaccine which can affectively protect against this infection. So when we look at all of that information we see that people in Brazil, as in other countries, many of them are still very susceptible to the infection. Some of them, If they are infected are likely to develop severe consequences from the infection. And that if vaccine is available, WHO definitely recommends that vaccination is a very good way to protect people against this infection. So we are not changing any of our recommendations for influenza vaccination but continue to endorse them. Thank you.

    Gregory Hartl:
    Thank you very much Dr Fukuda. Before we move to the next question, I would like to remind journalists that if they have a question, they should dial 01 on their keypad to get into the queue. So the next question is from Andrea at Bloomberg, go ahead please.

    Andrea, Bloomberg:
    Hi Dr Fukuda, could you just give us an update on the number of people estimated to have died, who have been laboratory confirmed cases, and also did the emergency committee decided not to change its recommendations because it was concerned that countries might stand down on the control measures they were taking?

    Dr Fukuda:
    OK, thank you for the question. I believe that the current estimates of laboratory confirmed deaths are something over 16,000. I do not have the exact numbers here, but we can provided them to you if contact the media people here. Now in terms of the, what really drove the discussions at the emergency committee, I think the most important point that they noted was that, they saw that the disease situation was different in different parts of the world. You know, there was lot of discussion of what was being seen in one country, is not the same as what was being seen in another country, and that given the situation that, for example, in West Africa, we are not just beginning to see increases and entry of pandemic influenza into that part of the world, and that Southern Hemisphere is getting ready to go into the winter months. These are really the dominating concerns of the committee. And this is why they said, you know, it is really probably too early for us to advice or give views on whether we are in a post-peak period or not. But in going through those discussions, they were very broad and they went into in-depth on a lot of issues. They also noted that they did not want to undermine control and actions being taken in other countries. But the dominating consideration was what the epidemiological picture in the world. Thank you.

    Gregory Hartl:
    Before we move to the next question, I would like to remind journalists that if they have follow-up, they can contact us at, and our dedicated phone line for pandemic influenza is +41 22 791 5000. So if any other journalist have a question, can we remind you again, pleas to dial 01 on your keypad, to get into the queue, and until we have any more questions, I will take this opportunity again to remind you that the audio transcript of this briefing will be up on the WHO website, which is very shortly, after the end of this briefing and the written transcript will be up later in the day.

    So now we will move to the next question which is from NHK, go ahead please.

    Hello Mr Fukuda, thank you so much for your brief. Just one question about the details of which country is seeing the increase of pandemic, in Africa, is it only 2 countries, Senegal and the other one?

    Dr Fukuda:
    Yes, two countries that we are getting increases in laboratory confirmed infections are Senegal and in Mauritania. I think that we will be working to try to see whether there is additional information from other countries in the area. But these are the countries in which we have the laboratory confirmations. Thank you.

    Gregory Hartl:
    Dr Fukuda, thank you very much, and if there are not any further questions in the next minute or so, we will say goodbye for the day, but I am seeing that there is another question coming through. Can you go ahead please?

    Frank Jordan, Associated Press:
    Yes just a quick follow-up from my only one and also the answers you gave to the other questions. It seems to me like the pandemic recommendations are pretty sort of blunt instruments, if the current situation in Senegal and Mauritania is what is holding up a phase change or recommendation change for the whole or the rest of the world?

    Dr Fukuda:
    Thank you! Is that a question or a comment?

    Frank Jordans, Associated Press:
    Do you have any comment on that? Is it fair that, you know, the situation one corner of the world is being used to make recommendations to the whole of the rest of the world?

    Dr Fukuda:
    Frank, I think that is a very good and difficult question in a certain way. I think that, If we look at how the world deals with these large global events, I think that some of the recommendations made at the global level certainly are blunt because they are really intended to be relevant and germane to the world. But it is also clear for example, that the situation can vary from region to region or from country to country, but to handle those situation also, you know there are recommendations which of course are made by regional authorities or made by national authorities. And so the discussions held yesterday really reflected that reality, that in the world we really have a different situation going on. But also remember much of the discussion did revolve around what is going to happen in the next few months, in the Southern Hemisphere. And that based on how we know influenza typically behaves including pandemics, that in the winter months, you can expect to see a kind of activity that you do not see in the summer months. And so all of these went into to the discussions, and one of the things which I drew from that, is that, you know, again, we have to be very mindful, not to try to oversimplify what is going on in the world or oversimplify how we look at what is going on in the world. So I think that it is not simply the fact that we have activity going on in one part of the world, but we have that, and also we some reason to be concerned about what may develop as have of the world goes into its winter months. So, again the discussions are really quite realistic about these things and, point out the difficulties of two rapidly or two oversimplifying what the issues are. So any way, so I hope that that is helpful. Thank you.

    Gregory Hartl:
    OK, thank you very much. Before we move to the next question, I can confirm that the latest count that we have of the number of laboratory confirmed deaths, so again, these are laboratory confirmed, is 16,226 deaths, as for this moment, confirmed in the laboratory. So we will move to one more question, and that will be from Lisa Schnirring, of CIDRAP News, good morning. We know it is very early for you, welcome and over to you and to Keiji.

    Lisa Schnirring, CIDRAP:
    Thanks so much for taking the question. I have a two-part question, both relating to the Southern Hemisphere. Am wondering if there is anything that usually happen there this time of the year, the kind of things that you watch for, events like school starting or the weather changing. Anything that seems to be related to flu getting going there, or anything they might already be seeing that is changed in the last week or two. The second last of my question is, regarding vaccination in the Southern Hemisphere. Are most of the countries getting the monovalent pandemic vaccine or are they getting seasonal vaccine that has the pandemic strain in it? Thanks so much!

    Dr Fukuda: Thank you Lisa. In terms of your first question, probably the most important predictor of when we might see activity pick-up in the Southern Hemisphere is simply what part of the year we are in. As you know with pandemic influenza, we can see activity occur in summer months. This is an atypical seasonality compared to regular influenza. But we also know that for both seasonal influenza and for pandemic influenza, entering into the winter months means that you are entering into the period when you are most likely to see influenza activity occur. So I think that that is really probably the most important thing to know, just where we are in terms of the year. Otherwise, we do not have, you know, we can see activity occur in schools and in communities, but its really the time of the year which is probably the most important marker.

    Now in terms of the your second question, monovalent versus trivalent vaccine, for the past year, the vaccine which has been available for the pandemic has been monovalent vaccine, that is a vaccine containing one virus specific to the pandemic virus. Now last year, in September, the health authorities in the Southern Hemisphere went on to decide that the vaccine that they would be recommending for use in the Southern Hemisphere now in the year's winter, would be a trivalent vaccine, containing the pandemic virus plus two seasonal influenza viruses.

    And so most of the vaccine that will be available there, will be trivalent vaccine. It may be possible that there will be monovalent vaccine use, but I expect that more of it will be trivalent vaccine in the southern hemisphere. But currently, we are in an interesting
    period where both vaccine are available. Thank you.

    Gregory Harlt:
    Dr Fukuda, thank you very much. The next question is from Jules Carron, of Kyodo News in Geneva, please go ahead.

    Jules Caron, Kyodo News:
    Thank you Dr Fukuda. I have two small questions. First of all, decisions within the emergency committee, how are they taken? Is it a vote? Is it unanimity? And basically, what were the numbers? Were they half one to two, to post-peak and half wanted to stay? And second is, you said you will be meeting again in a few weeks. You will be meeting in a few weeks to ask yourself the same questions? Is that right?

    Dr Fukuda:
    Thank you. The way that the committee works in terms of its discussions is that the committee is run by the chairman, who often goes around and will ask each of the members specifically for their views when a question is raised, and then there will be general discussion. And then the views really come together as a consensus. So in terms of the discussion that were held yesterday, the points that were made about not having enough information at this time, and wanting to revisit the issue was really a
    consensus decision in which I think it is fair to say that it was the unanimous view of the emergency committee.

    Now when the committee is brought back again, and again, I do not have precise timing of this, because this will depend on how the situation evolves around the world. But when the committee comes back together, sometime over the next several weeks, they will again be presented with the situation, the epidemiologic situation, and I expect we will again go into another discussion about where are we in terms of the pandemic situation and are they are ready to provide any views on whether there should be changes in the phases and whether there should be any changes in any recommendations. So I expect that the questions will be similar to what were raised at yesterday's meetings. Thank you.

    Gregory Hartl:
    Thank you Dr Fukuda. And now to our last question which is from Lisa Schlein from VOA. Lisa go ahead please.

    Lisa Schlein, Voice of America:
    Dr Fukuda, you mentioned that the pandemic is emerging now in Senegal and Mauritania. Now are you concerned that, it might actually blow up and become out of control in the African continent because of the poverty, of the continent, I think that is probably less prepared in terms of vaccinations, and other control measures than countries in the richer part of the world. And what measures are you taking in order to prevent the situation from really becoming, well out of control as I say.

    Dr Fukuda:
    Thanks Lisa. I think that the recent activity which has been reported from Western Africa, one points out that we should not be complacent about where activity may be going on. So for example there have a lot of reports coming out in North America and in western Europe about how activity is low. But what is going on in those parts of the world does not necessarily reflects what is going on in other parts of the world. Now in terms of Africa specifically, because there a number of chronic conditions, and because the conditions like poverty and sometimes difficulty accessing health services, it is clearly a continent and an area which our concerned about. We always spend time in thinking about how we can best support efforts by health authorities there to protect their populations against a wide variety of disease not just pandemic influenza, but of course other diseases like malaria, tuberculosis, HIV, and so on. So in this particular situation with the pandemic, there had been extensive efforts going on since the start of the pandemic, to provide health authorities there with diagnostic tools, with guidelines on clinical care of patients who are at home, and those kind of efforts And in addition, there has really been a very extensive effort to ask richer countries and vaccine manufacturers to provide vaccines and ancillary supplies, like syringes, so that developing countries, many of them in Africa, are also able to access some of the essential tools like vaccines. So all of these efforts have going on since the start of the pandemic, and we continue with them in there is no let up in these efforts right now. Thank you.

    Gregory Hartl:
    Dr Fukuda, thank you very much, and journalist to you also thank you very much. This has been the WHO virtual press briefing for today, 24th February 2010, and the audio transcript of this briefing will be up shortly on the WHO website,, and later in the day, we will have the written transcript up there for you too. So once again thank you very much to all. Good bye!

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